Many suturing devices are known in the art that puncture the skin with needles and percutaneously deliver sutures to the site. For example, PCT Patent Application WO 2009069119 discloses a suturing assembly 10, which is briefly described here with reference to FIGS. 1 and 2.
Suturing assembly 10 includes a first puncture element 12 including a sharp distal end 14 for puncturing tissue, and a second puncture element 16 including a sharp distal end 18 for puncturing tissue. The distal ends 14 and 18 of first and second puncture elements 12 and 14 are spaced from each other by a gap 20. Preferably, but not necessarily, first and second puncture elements 12 and 14 are parallel to each other.
First and second puncture elements 12 and 16 are hollow. A suture manipulating assembly 22 that includes a suture thread receiving member 24 and a suture grabber 26, which can be passed into the hollow portions of first and second puncture elements 12 and 16, respectively. First and second puncture elements 12 and 16 are provided with distal funnel cups 28 and 30, respectively, for guiding insertion of suture thread receiving member 24 and suture grabber 26. The funnel cups 28 and 30 also serve as stops to limit movement of suture thread receiving member 24 and suture grabber 26 into first and second puncture elements 12 and 16. Proximal ends of suture thread receiving member 24 and suture grabber 26 are mounted on a handle assembly 32. Suture thread receiving member 24 is mounted on an adjustable block 17 of handle assembly 32. Adjustable block 17 is arranged for moving with respect to a distal block 19 of handle assembly 32.
Suture thread 38 is placed over a distal end of suture thread receiving member 24. As seen in FIG. 2, the suture grabber 26 is arranged to grab suture thread 38 at the distal end 14 of first puncture element 12 and pull suture thread 38 over the gap to second puncture element 16.
Briefly, in operation of suturing assembly 10, first and second puncture elements 12 and 16 are first pushed into tissue and the sharp distal ends 14 and 18 puncture a tissue wall. The suture thread receiving member 24 and suture grabber 26 are introduced into the hollow portions of first and second puncture elements 12 and 16, respectively. When the suture thread receiving member 24 is pushed fully up to funnel cup 28, the suture thread 38 passes from a near side of the tissue wall to a far side of the tissue wall. When suture grabber 26 is pushed fully up to funnel cup 30, suture grabber 30 swings out of second puncture element 16 towards the suture thread 38 at the distal end 14 of first puncture element 12. Suture thread 38 is now caught and grabbed by suture grabber 26, as seen in FIG. 2. The suture thread receiving member 24 and suture grabber 26 are then pulled proximally (backwards). This movement pulls suture grabber 26 back into second puncture element 16. As suture grabber 26 moves proximally it brings along with it suture thread 38 over the gap 20, proximally away from the distal end 18 of second puncture element 16, and back through to the near side of the tissue wall. Afterwards, the suture thread 38 may be secured to form a stitch.